重症监护病房中心静脉导管相关感染的临床研究

[目的]了解重症监护病房中心静脉导管相关感染（CVC-RI）的原因。[方法]以回顾性调查方法对发生CVC-RI病人的一般情况、基础疾病、使用导管腔数、置管时间、置管部位、细菌学检查结果进行统计分析。[结果]CVC-RI与年龄、性别、基础疾病无关,但与置管时间、导管腔数有关。锁骨下静脉置管发生感染的比例最低。CVC-RI病原菌中革兰阳性菌、阴性菌和真菌发生感染的比例无统计学意义。[结论]应尽量选择在锁骨下静脉置管,控制置管时间和导管腔数,高度重视致病菌菌谱的变化。     

ICU中心静脉导管相关性血流感染的危险因素分析及干预措施

目的研究重症监护病房(ICU)中心静脉导管相关性血流感染的危险因素及干预措施。方法选取2018年3月-2020年9月我院ICU接受中心静脉置管的患者765例作为研究对象。根据是否发生导管相关性血流感染分为感染组41例和无感染组724例。分析两组各项基线资料及治疗情况的差异,并以多因素Logistic回归分析明确ICU中心静脉导管相关性血流感染与各项影响因素的关系。结果感染组年龄、入院时APACHEⅡ评分以及高血压、糖尿病、心脑血管疾病人数占比均高于无感染组(P<0.05)。感染组机械通气、应用多腔导管、静脉营养人数占比以及穿刺次数、导管留置时间、应用广谱抗生素种类均高于无感染组(P<0.05)。多因素Logistic回归分析结果显示,年龄、高血压、心脑血管疾病、入院时APACHEⅡ评分、机械通气、导管留置时间、应用广谱抗生素种类为ICU中心静脉导管相关性血流感染的危险因素(P<0.05)。结论ICU中心静脉导管相关性血流感染的危险因素包括年龄、高血压、心脑血管疾病、入院时APACHEⅡ评分、机械通气、导管留置时间、应用广谱抗生素种类。临床实际工作中应针对上述危险因素进行干预,以达到降低感染风险发生的目的。     

重症医学科中心静脉导管相关感染13例分析及护理对策

目的对重症医学科发生中心静脉导管相关感染的原因进行分析并采取相应的对策。方法分析重症医学科中心静脉置管217例患者导管相关感染情况。结果发生感染13例,感染率6%;导管相关血流感染4例,感染率1.8%;局部感染9例,感染率4.1%。结论 (1)导管留置时间延长,感染率增高。(2)颈内静脉置管感染率较锁骨下静脉置管感染率高。(3)置管过程中及置管后严格执行无菌操作等对发生导管相关性感染也非常重要。     

建立导管日志控制呼吸ICU中心静脉导管相关性血流感染的效果

目的 了解ICU中心静脉置管患者中心静脉导管感染现状,探讨建立导管日志控制中心静脉导管相关性血流感染(CRBSI)的效果.方法 采用类实验性研究方法,便利选取北京市某三甲医院呼吸监护室留置中心静脉导管的患者.对照组51例患者采取常规的护理措施,干预组43例患者采取以建立导管日志为主的一系列护理干预措施.比较两组患者CRBSI的发生率.结果 对照组发生感染5例(9.8％),干预组发生感染0例,两组比较差异有统计学意义(x2 =4.453,P＜0.05).干预组导管的千日感染率为0.00,对照组为4.36‰.干预组记录完整的日志为31条(72％)导管,记录不完整的12条(28％).结论 建立导管日志,切实做好无菌操作、管路观察及维护等一系列护理干预措施能够降低CRBSI的发生率.     

重症监护病房中心静脉导管相关性感染的临床分析

中心静脉导管（Central venouscatheter,CVC）在ICU已广泛应用于血流动力学监测、输液、胃肠外营养支持以及血液净化等治疗,但在应用过程中出现的导管相关性感染也越来越多。本文对我院综合ICU近3a以来确诊的36例中心静脉导管相关性感染病例进行分析,探讨其菌群分布情况及相关影响因素。寻找预防及治疗中心静脉导管相关性感染的依据。     

中心静脉导管相关性感染的护理进展

中心静脉导管现已在临床上广泛应用于血流动力学监测、输液、胃肠外营养支持及血液净化治疗。尽管穿刺技术和中心静脉导管的材质都有了很大的改进和提高,但中心静脉置管仍然是菌血症的重要来源,占医院内与血管内装置相关的菌血症的80％以上。     

ICU中心静脉导管相关性感染危险因素分析

目的 分析ICU中心静脉导管相关性血流感染(CRBSI)的危险因素,为预防控制感染提供参考依据.方法 对ICU患者中心静脉导管(包括picc)使用情况进行目标性检测,回顾性分析.结果 CRBSI千日导管感染率从7.98‰下降至4.31‰,感染病原菌共25株,革兰阴性菌23株,占92％,革兰阳性菌2株,占8％.随着导管留置时间延长,感染率也随之增高.结论 做好医务人员培训,规范深静脉置管操作,缩短导管留置时间,加强手卫生,能有效预防和控制CRBSI的发生.     

重症监护病房中心静脉导管相关血流感染与干预措施

摘要 目的 研究中心静脉导管相关血流感染的防控干预措施及其效果。方法 通过感染监测和细菌定量检测方法,对某医院重症监护病房（ICU）中心静脉导管相关血流感染干预措施的效果进行评价。结果 2012-2015导管相关血流感染（CRBSI）千日感染率分别为7.02‰、1.93‰、0.83‰、0.29‰,感染率逐年下降（P＜0.01）。 结论 开展目标监测、最大无菌屏障、2%葡萄糖酸洗必泰皮肤消毒等干预措施可有效降低CRBSI的感染率。     

集束化护理预防ICU患者中心静脉导管相关性血流感染的效果

目的:探讨集束化护理措施预防ICU患者中心静脉导管相关性血流感染的效果。方法:选取2013年1~9月收治的287例留置中心静脉导管的重症患者作为对照组,选取2014年1~9月收治的342例留置中心静脉导管的重症患者为试验组,对照组实施常规护理,试验组实施集束化护理。对两组患者的导管相关性血流感染发生情况、住院时间、导管留置时间进行对比分析。结果:试验组导管相关性血流感染发生情况少于对照组,差异有统计学意义(P0.05)。试验组患者住院时间比对照组明显短,两组比较有差异有统计学意义(P0.05)。试验组导管留置时间也比对照组患者短,两组比较差异有统计学意义(P0.05)。结论:集束化护理能有效预防ICU患者中心静脉导管相关性血流感染,进一步优化护理措施。     

中心静脉导管相关感染的研究进展

中心静脉导管（Central Venous Catheter,CVC）现已在临床上广泛应用于静脉给药、血液净化、监测血流动力学、中心静脉测压及静脉营养支持治疗等,其亦成为心脏直视术后一种常规的治疗方法。尽管穿刺技术和CVC的材质有了很大的提高和改善,但由于CVC直接与心脏及血液循环相连,     

中心静脉导管相关血流感染的研究进展

中心静脉导管相关血流感染已经成为医院最常见的医院内获得性感染之一.作者结合国内外最新的研究进展,对中心静脉导管相关血流感染的流行病学、发病机制、诊断及预防和护理进行综述.     

Strategic patient education program to prevent catheter-related bloodstream infection

Central venous catheters (CVCs) are used commonly for venous access during treatment, and catheter-related bloodstream infection (CRBSI) is a frequent, yet highly preventable, hospital-acquired infection. One of the performance elements of the Joint Commission's 2012 National Patient Safety Goals addresses the education of patients and family members on CVC care and management, as well as CRBSI prevention before a central catheter is inserted. This article presents the history and roles of the Infusion Therapy Team at the University of Texas MD Anderson Cancer Center in CVC care and describes an organized patient education program that plays a key part in the institution's strategy to reduce and prevent CRBSI. Institutional standard policies and procedures for patient care should be in compliance with guidelines of the Centers for Disease Control and Prevention and the Joint Commission before any patient educational initiative is implemented. Such standards will serve as a guide to set up, organize, and implement an effective program.     

超声引导下静脉穿刺降低导管相关性血流感染的探讨

目的探讨超声引导下静脉穿刺对降低导管相关性血流感染的临床研究。方法选取2010年6月至2013年6月该院行血管内导管留置术的240例患者作为研究对象,按照置管方式不同分为超声引导组(125例)和传统对照组(115例),比较2种静脉穿刺置管方式的穿刺效果,并观察2组在导管相关性血行感染发生率上的差异。结果超声引导组和对照组穿刺时间分别为(3.4±1.3)和(9.8±4.1)min,差异有统计学意义(P0.05);超声引导组颈内静脉穿刺、锁骨下静脉穿刺和总的静脉穿刺成功率分别为90.1%、88.9%、89.6%,而对照组分别为64.6%、62.0%、63.5%,差异有统计学意义(P0.05);对照组颈内静脉穿刺、锁骨下静脉穿刺和总的静脉穿刺并发症发生率分别为12.3%、14.0%、13.0%,其中导管相关性血行感染并发症发生率分别为7.7%、8.0%、7.8%,而超声引导组尚无一例并发症发生,差异有统计学意义(P0.01、P0.05)。结论超声引导下静脉穿刺能明显缩短穿刺时间并提高首次穿刺成功率,并能明显降低导管相关性血流感染发生率。     

Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit

Objective  

Identification of catheter-related bloodstream infection (CR-BSI) risk factors and determination of whether intervention related to identified risk factors would reduce CR-BSI rates.     

血管内导管相关性血流感染预防的新进展

综述了导管相关性血流感染的流行病学、危险因素、感染途径及预防策略.     

Risk factors for central venous catheter-related bloodstream infection: a 1073-patient study

We intended to evaluate the risk factors for catheter-related bloodstream infection (CR-BSI) with central venous (CV) catheters. For the hub of the CV line, we used three-way stopcocks in the first year of the study and closed needleless connectors (NCs) in the second year. Background factors included the age and sex of patients; the ward; the specialty service; the CV catheter and its days of placement; and the staff compounding the intravenous infusion, i.e., either nurses, who disinfect hands-free, or pharmacists using clean benches. Outcome factors included positive culture from the blood-related samples and the body temperature estimate. Of a total of 29 221 device-days in 1073 patients, positive cultures showed an overall incidence of 2.26 per 1000 device-days. Multivariate analysis showed a higher odds ratio of positive cultures for the ICU (odds ratio [OR], 4.415; 95% confidence interval [CI], 2.054–9.490]) and for CV catheter placement for more than 30 days (OR, 7.529; 95% CI, 4.279–13.247), but no significance for male sex (OR, 1.752; 95% CI, 0.984–3.119) or for pharmacists’ compounding (OR, 2.150; 95% CI, 0.974–4.749). Univariate analysis showed no significance for the following factors: age more than 70 years (OR, 0.968; 95% CI 0.561–1.641), the surgery service (OR, 1.029; 95% CI, 0.582–1.818), double-lumen CV catheters (OR, 0.841; 95% CI, 0.465–1.521), or the NC (1.107; 95% CI, 0.673–1.821). We conclude that the theoretical benefit of the NC, the abolished dead space in the hub, contributed little to the outcomes of blood-related culture. The hands-free disinfection may have resulted in comparable odds ratios for the nurses and the pharmacists compounding the infusions.     

目标管理方案降低导尿管相关性尿路感染发生率的临床实践

目的 实施目标管理方案降低导尿管相关性尿路感染发生率,通过制订目标、实施目标、完成目标,推进质量改善。方法 对某三级甲等综合医院2020年4月—9月留置导尿管的住院患者,应用目标管理方案,依次制订质量改善目标、质量改善计划,实施计划并对过程进行质量评价,通过评估结果的反馈改进行动,实现质量改善。设定1个月为1个质量周期,首个周期的质量为基线,之后各周期质量与之比较,同时与前1周期质量比较。结果 12个过程指标与基线质量比较,6个指标在第2个周期得以改善（P<0.05）,此后凡优于第2周期和基线质量的指标,较基线质量比较,差异均具有统计学意义（均P<0.001）。5个过程指标基线完成率已达到较高水平,与后续测量数据持平。结果指标导尿管相关性尿路感染发生率项目末期较基线显著降低（P<0.05）。过程指标10项措施执行完成率≥95%,2项措施执行率≥91%,达成目标。结论 应用目标管理方案进行质量改善,实现目标导向指标具体化管理,对护理质量进行客观测量,科学比较,切实降低了留置导尿管住院患者的导尿管相关性尿路感染发生率,促进护理质量提升。     

Microorganisms responsible for intravascular catheter-related bloodstream infection according to the catheter site

OBJECTIVE: Current guidelines for the management of intravascular catheter-related bloodstream infection (IVC-RBSI) recommend that empirical antimicrobial therapy must have activity against Gram-positive bacteria, but additional empirical coverage for Gram-negative bacteria may be needed for severely ill or immunocompromised patients, and antifungal therapy may be needed in some situations. We hypothesized that the spectrum of etiological microorganisms responsible for IVC-RBSI and, in relation to that, the choice of empirical antimicrobial therapy depends on the catheter insertion site. We therefore compared the proportion of IVC-RBSI due to Gram-negative bacteria and yeasts according to catheter site. DESIGN: Prospective cohort study from May 1, 2000, to April 30, 2004. SETTING: A 24-bed medical-surgical intensive care unit in a 650-bed tertiary hospital. PATIENTS: Patients requiring a central venous or arterial catheter. MEASUREMENTS AND MAIN RESULTS: We diagnosed 88 IVC-RBSIs, comprising 36 femoral catheter sites (26 femoral venous and ten femoral arterial sites) and 52 other catheter sites (36 jugular venous, 11 subclavian venous, and five radial arterial sites). No differences were found between IVC-RBSI of femoral vs. other catheter sites for age, sex, Acute Physiology and Chronic Health Evaluation II, diagnosis at admission, use of antimicrobials, the time the catheter responsible for IVC-RBSI had been in place, or the duration of intensive care unit stay before IVC-RBSI. The proportion of IVC-RBSIs due to Gram-negative bacteria was higher in femoral, 14 of 36 (38.89%), than in the other catheter sites, 4 of 52 (7.69%) (odds ratio, 7.48; 95% confidence interval, 2.19-25.54; p = .001). Also, the proportion of IVC-RBSIs due to yeasts was higher in femoral, 6 of 36 (16.67%), than in the other catheter sites, 1 of 52 (1.92%) (odds ratio, 10.20; 95% confidence interval, 1.17-88.85; p = .035). CONCLUSIONS: Empirical antifungal therapy would seem to be indicated in patients with suspected femoral catheter-related bloodstream infection.     

The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters

OBJECTIVE: Short-term, noncuffed, percutaneously inserted central venous catheters (CVCs) are widely used and cause more than 250,000 bloodstream infections (BSIs) in hospitals each year in the United States. We report a prospective study undertaken to determine the pathogenesis of CVC-related BSI. DESIGN AND SETTING: Prospective cohort study in a university hospital 24-bed medical-surgical intensive care unit. PATIENTS AND PARTICIPANTS: Patients participating in two randomized trials during 1998-2000-one studying the efficacy of a 1% chlorhexidine-75% alcohol solution for cutaneous antisepsis and the other a novel chlorhexidine-impregnated sponge dressing-formed the study population; CVC-related BSIs were considered to be extraluminally acquired if concordance was identified solely between isolates from catheter segments, skin, and blood cultures and intraluminally acquired if concordance was demonstrated only between hub or infusate and blood culture isolates, as confirmed by DNA subtyping of isolates from blood and catheter sites or infusate. RESULTS: Of 1,263 catheters (6075 CVC days) prospectively studied, 35 (2.7%) caused BSI (5.9 per 1000 CVC days); 27 were caused by coagulase-negative staphylococci. Overall, 45% of infections were extraluminally acquired, 26% were intraluminally derived, and the mechanism of infection was indeterminate in 29%. In the pooled control groups of the two trials, 25 CVC-related BSIs occurred (7.0 per 1000 CVC days), of which 60% of infections were extraluminally acquired, 12% were intraluminally derived and 28% were indeterminate. In contrast, CVC-related BSIs in the treatment groups were most often intraluminally derived (60%, p=0.006). CONCLUSIONS: Most catheter-related BSIs with short-term percutaneously inserted, noncuffed CVCs were extraluminally acquired and derived from the cutaneous microflora. Strategies achieving successful suppression of cutaneous colonization can substantially reduce the risk of catheter-related BSI with short-term CVCs.